I-2-1-13.Prior Claim(s) Files

Last Update: 6/9/14 (Transmittal I-2-110)

A. General

In some cases, it will be necessary for the administrative law judge (ALJ) to review a prior claim(s) file in order to fully adjudicate a current claim. Hearing office (HO) staff will determine whether the claimant filed a previous application by checking the Master Beneficiary Record for title II claims and the Supplemental Security Income Detailed query for title XVI claims. If there was a previous filing, HO staff will add a message in eView and a Remark in the Case Processing and Management System.

HO staff will initially evaluate whether a prior claim(s) folder is required under Hearings, Appeals and Litigation Law (HALLEX) manual I-2-1-13 B.1., as set forth below. If the prior claim(s) file is not required, HO staff will consult with the ALJ as to whether he or she needs the prior claim(s) file in order to fully evaluate the issue(s).

NOTE:

The availability of a prior claim(s) file is subject to Federal file retention periods as noted in HALLEX I-2-1-10 D.

B. When to Consider Evidence in a Prior Claim(s) File

1. Considering Evidence in Prior Claim(s) File is Required

HO staff will request a prior claim(s) file, without needing to consult with the ALJ, in the following circumstances:

  • The pending claim is before the ALJ based on a continuing disability review. See 20 CFR 404.1593 and 416.993.

  • The pending claim involves a collateral estoppel issue (HALLEX I-2-2-30). For example, if the claim before the ALJ is title II and there is a prior title XVI allowance addressing an overlapping time period, the ALJ will need to consider the evidence in the title XVI claim file.

  • The pending claim involves a possible reopening and/or res judicata issue (HALLEX I-2-9 and I-2-4-40).

  • The ALJ must consider findings of an ALJ or the Appeals Council on a prior claim(s) to comply with an Acquiescence Ruling (AR). (See HALLEX I-2-6-58 B for specific examples of ARs that may apply).

  • Fraud or similar fault may be involved in the current or prior claim (HALLEX I-1-3 and I-2-10).

2. Considering Evidence in Prior Claim(s) May Be Necessary

HO staff must consult with an ALJ about obtaining a prior claim(s) file when it may be necessary for a full adjudication of the issues before the ALJ. An ALJ will generally find that evidence in a prior claim(s) file is necessary for a full adjudication of the issues when the ALJ determines:

  • There is a need to establish a longitudinal medical, educational, or vocational history; or

  • The impairment is of a nature that evidence from a prior folder could make a difference in establishing whether disability is present in the current claim.

NOTE:

ALJs should keep in mind that even when a prior claim(s) file is not required, failure to obtain and consider evidence in a prior claim(s) file may constitute a reason for remand from the Appeals Council (depending on the facts of the case).

3. Prior Claim(s) File Is Not Needed

Unless one of the circumstances above exists, HO staff is not required to request a prior claim(s) file when:

  • There is no possible reopening issue;

  • The file shows that any onset date that might be established occurs after the disability earnings requirement is last met;

  • The claimant alleges “onset” within the past year and medical evidence submitted does not indicate the presence of an impairment(s) that might warrant an onset more than one year ago; or

  • Work that is determined to be substantial gainful activity was performed for more than six months during the l-year period preceding the filing date of the current application.

C. Requesting a Prior Claim(s) File

HO instructions for requesting a prior claim(s) file are set forth in the HO electronic business process (eBP) section 1.4 A.5. Generally, when a prior claim(s) file is not located in the HO, the HO will request it from the field office using an electronic assistance request. If there are additional prior claim(s) files that are paper, the HO will request them through the Automated Folder Locator and/or the Megasite Information Management System (MIMS).

D. Exhibiting Evidence From a Prior Claim(s) File

Detailed HO instructions for exhibiting evidence from a prior claim(s) file are set forth in the HO eBP sections 3.2 J and 3.2 K. Generally, the policy is:

  • If the prior claim(s) file was not exhibited, HO staff will add to the pending claim(s) file only documents from the prior claim(s) file that will be referenced as exhibits.

  • If the prior claim(s) file is paper and the file was exhibited, HO staff will add to the pending claim(s) file only the exhibit list, ALJ decision, and any appeal documents from the prior claim(s) file. The ALJ will then reference the relied upon information in the decision using the prior exhibit numbers.

NOTE:

If the prior claim(s) file is paper, the original copies of documents must be returned to the appropriate section of the prior claim(s) file after they are photocopied. The prior claim(s) file remains the official record of the prior claim(s).

E. Providing the Claimant an Opportunity to Review Prior Claim(s) File

As explained in HALLEX I-2-1-35, a claimant and appointed representative, if any, have the right to examine material that constitutes or will constitute the evidence of record. Any information on which the ALJ relies from a prior claim(s) file will be added to the record (as described in subsection D above) and will be made available to the claimant and appointed representative, if any, for review.

NOTE:

If the information is added to the record after the hearing, the ALJ must proffer the information using usual procedures in HALLEX I-2-7-30.

An ALJ does not have an obligation to provide a claimant an opportunity to review a prior claim(s) file if the ALJ does not rely on any information from the prior claim(s) file. However, when the ALJ has decided the prior claim(s) file is not necessary for a full review of the pending case, and a claimant or appointed representative requests to review the prior claim(s) file, the ALJ will generally grant the request if it is administratively efficient to do so and the prior claim(s) file is available. In cases where it is possible and more efficient to do so, HO staff may provide a CD copy of a prior claim(s) file to the claimant or appointed representative, if any.

F. Decision Requirements

When an ALJ relies on information from a prior claim(s) file, the ALJ will make the evidence part of the record in the pending claim, and address the evidence in the written decision using the instructions throughout HALLEX I-2-8-0. An ALJ is not required to address evidence on which he or she does not rely. Additionally, subject to applicable Acquiescence Rulings, an ALJ need not address a prior filing when the ALJ does not rely on any information in the prior claim(s) file.